Leaving for College: A Transition for Everyone

As the excitement of graduation builds for today's seniors, the quiet anxiety of starting college takes a back seat (for now). For many families, the short-lived celebrations and the tearful farewells mark the beginning of the greatest transition -the task of preparing physically and emotionally as the graduate leaves home. Using these next few months to prepare for the eventual separation helps both students and their families to feel more at ease come the beginning of the fall semester.

The Society for Adolescent Medicine (SAM) recognizes several important issues for parents and their young adults to address before they leave for college (see The Healthy Student: A Parent's Guide to Preparing Teens for the College Years, by Neinstein and Johnson, www.adolescenthealth.org). These range from independence and confidentiality to first aid supplies. While many of these issues may be addressed by the student's pediatrician or high school, some slip under the radar and should be tended to directly.

Independence and Confidentiality Issues. Most freshman are (or are soon to become) 18 years old, leaving their status as 'minors' behind. This means that they can make all medical decisions and sign their own medical consents (for physical or mental health matters). Thus parents may not be entitled to information about their children's health, and breaking this confidentiality without permission by the student is against the law. While this is often difficult for parents, it is helpful to understand that confidentiality is an important part of a student's transition to adulthood and will help him or her to talk openly with healthcare providers.

For unemancipted minors (still under parent or guardian supervision), parents are usually asked to sign a generic consent for treatment. In some states, minors may be treated without parental consent for certain medical conditions (such as reproductive health, mental health, and substance abuse problems). Of note, federal law since 1998 allows, but does not require, colleges and universities to notify parents if students under 21 violate drug or alcohol laws. Some schools have adopted policies allowing for mandatory parental notification.

Pre-College Health Exam. Most colleges and universities require a pre-college health exam. It is of extreme importance to make sure the immunization and health history information is up to date and that a physical exam is done to rule out any significant problems before leaving for school. It is an opportunity for your child's physician to review medical concerns that may affect school performance, including smoking, drinking, drug use, eating disorders, sexual practices, and mental health concerns. This is a good time to establish a different kind of relationship for your child with his or her local physician; for some, it may be a good time to transition to a provider with whom your child will feel comfortable discussing more mature health issues in the future.

Immunizations. Most young people are up to date on their primary childhood immunizations. However, recent additional recommendations have been made at a national level which may affect your child. Some schools have specific requirements or recommendations prior to matriculation that should be checked prior to the pre-college health exam. In particular, Hepatitis A and Hepatitis B status should be reviewed. Depending on the age of your student, he or she may have missed completing the entire series for either of these immunizations (2 shots for Hepatitis A, 3 for Hepatitis B). Meningococcal meningitis vaccine is strongly recommended for all college freshmen, especially if they will be living in dorms or other group residential environments. This vaccine is mandatory at many colleges and universities.

MMR (measles, mumps, rubella) vaccine should have been given twice, usually at 15 months and 4 years of age. For those who have documented one dose only, a booster is needed. Polio vaccine (OPV or IPV) is routinely required for admission to grade school; most students will not need to be immunized again for this. While not a vaccine per se, make sure your child has had a recent Tuberculosis Skin Test.

New recommendations have been released for booster vaccination for Tetanus that includes not just diphtheria but also pertussis (Tdap). Contact your primary care physician to see if this vaccine is available for your child. Varicella (chickenpox) immunization is recommended if your child has not had active disease or did not receive the Varivax immunization in the past. If being immunized for the first time for this, two doses are required for adolescents and adults.

Health Insurance. Up to 25% to 30% of college students have no health insurance. As most universities do not have facilities for overnight care, parents should ensure that their children will have adequate health insurance for their children to cover hospitalization, emergency room visits, specialty care, and diagnostic services. It is essential to review the details of coverage with your children with special attention to how they will or will not be covered in the geographic area they are attending school. While many academic institutions offer some form of health insurance and/or on-campus student health services, coverage varies significantly and can be confusing.

To make sure you understand the program offered by your child's college or university or, for that matter, your own dependent-care coverage, make sure to obtain the following information: 1) Network: Does the coverage include the relevant geographic area? 2) Deductible: How much does the student have to pay before any coverage applies? 3) Copay: How much does the student pay per visit? 4) Lifetime Maximum: Is there a limit? Are there limits on the numbers of visits or types of visits that are covered? 5) Pre-existing conditions: Are there exclusions? For how long? 6) Specific Coverage: Are there some types of conditions that are not covered (e.g. eating disorders, mental health concerns)? Are club sport injuries covered? What about NCAA athletic injury coverage? 7) Insurance Card: Is the student provided an individual card with adequate identifying information? Make sure your child knows to keep this accessible at all times. 8) Double Coverage: Sometimes the school-sponsored program is a better fit than the parents' private coverage. Will it be hard to re-enroll in the family policy after school is over? What happens when a student with a school policy is not near campus? Which insurance applies when both cover a problem? 9) Prescription/Lab/Xray Coverage: These are handled separately from physician care in some universities. Make sure to check how this works at your child's school.

Medical Records and Prescriptions. It is very important for students to have access to a hard copy of their health records, especially if they have any chronic medical conditions. A copy can be sent ahead to the student health center for review by their medical staff; most student health physicians are happy to receive advance information from a parent or student about any potentially chronic or life-threatening illnesses. Make sure that records include a list of medications (including name, dosage, frequency, and reason it is prescribed), known medication and non-medication allergies (along with descriptions of the reactions which occur when encountered), significant family medical history, and prior health problems (even if they have resoled).

Student Health Center. When possible, visit the on-campus student health center prior to the fall enrollment period or during orientation. Most student health centers provide high quality, low-cost, accessible primary health care and health education services (the days of the 'Quack Shack' are mostly over). Find out about after-hours care, what specialty services are available, and which emergency room they would recommend if any untoward events were to occur. Some have in-house pharmacies, labs, and radiology facilities as well. Find out how these services are (or are not) included in the student fees or health insurance products. Importantly, if your child has a history of an eating disorder or other mental health concern, insist that she or he establish a relationship with a school psychologist or therapist early in the freshman year, just in case problems arise in the future. The stress of the college transition often brings out previous maladaptive or dangerous 'coping' mechanisms, even in patients in remission.

First Aid. Send your child with the 'essentials' of your home medical cabinet, such as basic cold medications, lozenges, acetaminophen, and ibuprofen; include a digital thermometer and first aid items in case of injury, such as bandages, antiseptic wash, antibiotic ointment, and a chemical cold pack. Review instructions for minor emergencies.

Risk Behaviors. Remind your child that you were once 18 and that you understand the pressures and freedoms facing college students. Begin, if you have not already, to discuss risks to academic and personal success, such as alcohol, drugs, and sexuality. Encourage your child to adjust to newly found freedoms with maturity and respect for consequences. Provide guidance about how to be social without being intoxicated. Be open to acknowledging sexual curiosity while supporting your child's ability and right to be responsible in making choices. Your willingness to discuss these issues makes it more likely that he or she will turn to you should a crisis occur. Provide access to appropriate resources should your child need help in any of these areas.

In Summary: Preparation, as in all things, gives the greatest chance of success in most endeavors. A little homework in getting ready for the college health scene will go a long way.

By: Susan Sugerman, MD, MPH (2006)
www.gtw-health.com

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